Wash. Rev. Code » Title 48 · Chapter 48.43
Revised Code of Washington

Wash. Rev. Code § 48.43.0128 (2026)

✓ current as of May 2026
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(1) A health carrier offering a nongrandfathered health plan or a plan deemed by the commissioner to have a short-term limited purpose or duration, or to be a student-only plan that is guaranteed renewable while the covered person is enrolled as a regular, full-time undergraduate student at an accredited higher education institution may not:
(a) In its benefit design or implementation of its benefit design, discriminate against individuals because of their age, expected length of life, present or predicted disability, degree of medical dependency, quality of life, or other health conditions; and
(b) With respect to the health plan or plan deemed by the commissioner to have a short-term limited purpose or duration, or to be a student-only plan that is guaranteed renewable while the covered person is enrolled as a regular, full-time undergraduate student at an accredited higher education institution, discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, or sexual orientation.
(2) Nothing in this section may be construed to prevent a carrier from appropriately utilizing reasonable medical management techniques.
(3) For health plans issued or renewed on or after January 1, 2022:
(a) A health carrier may not deny or limit coverage for gender-affirming treatment when that treatment is prescribed to an individual because of, related to, or consistent with a person's gender expression or identity, as defined in RCW 49.60.040, is medically necessary, and is prescribed in accordance with accepted standards of care.
(b) A health carrier may not apply categorical cosmetic or blanket exclusions to gender-affirming treatment. When prescribed as medically necessary gender-affirming treatment, a health carrier may not exclude as cosmetic services facial feminization surgeries and other facial gender-affirming treatment, such as tracheal shaves, hair electrolysis, and other care such as mastectomies, breast reductions, breast implants, or any combination of gender-affirming procedures, including revisions to prior treatment.
(c) A health carrier may not issue an adverse benefit determination denying or limiting access to gender-affirming services, unless a health care provider with experience prescribing or delivering gender-affirming treatment has reviewed and confirmed the appropriateness of the adverse benefit determination.
(d) Health carriers must comply with all network access rules and requirements established by the commissioner.
(4) For the purposes of this section, "gender-affirming treatment" means a service or product that a health care provider, as defined in RCW 70.02.010, prescribes to an individual to treat any condition related to the individual's gender identity and is prescribed in accordance with generally accepted standards of care. Gender-affirming treatment must be covered in a manner compliant with the federal mental health parity and addiction equity act of 2008 and the federal affordable care act. Gender-affirming treatment can be prescribed to two spirit, transgender, nonbinary, intersex, and other gender diverse individuals.
(5) Nothing in this section may be construed to mandate coverage of a service that is not medically necessary.
(6) By December 1, 2022, the commissioner, in consultation with the health care authority and the department of health, must issue a report on geographic access to gender-affirming treatment across the state. The report must include the number of gender-affirming providers offering care in each county, the carriers and medicaid managed care organizations those providers have active contracts with, and the types of services provided by each provider in each region. The commissioner must update the report biennially and post the report on its website.
(7) The commissioner shall adopt any rules necessary to implement subsections (3), (4), and (5) of this section.
(8) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement subsections (1) and (2) of this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.
[ 2025 c 243 s 8; 2021 c 280 s 3; 2020 c 228 s 9; 2019 c 33 s 15.]

Notes:

Short title—2021 c 280: See note following RCW 49.60.178.
Effective date—2019 c 33: See note following RCW 48.43.005.
Notes of Decisions
Cited in 7 cases (7 in the last 5 years), 2022–2026 · leading case: Jeannette Simonton, V. Washington State Health Care Auth. (Wash. Ct. App. 2026).
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Jeannette Simonton, V. Washington State Health Care Auth. (Wash. Ct. App. 2026). · cites it 36× “But this carveout is subject to exceptions, including under RCW 48.43.0128. Id. So, the “fair discrimination” authorization is eliminated—and the general prohibition against discrimination is not subject to the exception—if the discrimination is prohibited by RCW 48.”
Luci Solorio, V. Regence Blueshield (Wash. Ct. App. 2026). · cites it 26× “60 RCW, and RCW 48.43.0128. The trial court denied Regence’s CR 12(b)(6) motion to dismiss and we accepted interlocutory review.”
Kurt Herzog V. Kaiser Found. Health Plan Of Washington, Et Ano (Wash. Ct. App. 2026). · cites it 12× “” Subsequently, Herzog’s insurer included preferred alternative prescription drug options for Herzog to discuss with a provider, such as topiramate, bupropion, and naltrexone, as well as over the counter medication, Alli. Herzog appealed his insurer’s decision declining…”
E.S. v. Regence BlueShield (W.D. Wash. 2022). · cites it 8× “Plaintiffs also 5 assert a claim for breach of contract and violation of RCW 48.43.0128. Id. ¶¶ 125-29. 6 Regence now moves to dismiss the amended complaint.”
E.S. v. Regence BlueShield (W.D. Wash. 2023). · cites it 4× “Claim under the Washington Law Against Discrimination (WLAD) 4 RCW 48.43.0128 prohibits health carriers from discriminating against individuals 5 due to “present or predicted disability” in both the design and implementation of its 6 benefit design.”
Schmitt v. Kaiser Found. Health Plan of Washington (W.D. Wash. 2022). · cites it 2× “28 ORDER DENYING DEFENDANTS’ MOTION 1 (2) Plaintiffs’ “Breach of Contract and Violation of RCW 48.43.0128” claim is also 2 plausible.”
E.S. v. Regence BlueShield (W.D. Wash. 2024). “” RCW 48.43.0128. This includes discrimination “on the basis of the presence of any 3 disability of the insured or prospective insured.”
— Wash. Rev. Code § 48.43.0128(1) — 2 cases
E.S. v. Regence BlueShield (W.D. Wash. 2022). “Plaintiffs also 5 assert a claim for breach of contract and violation of RCW 48.43.0128. Id. ¶¶ 125-29. 6 Regence now moves to dismiss the amended complaint.”
Kurt Herzog V. Kaiser Found. Health Plan Of Washington, Et Ano (Wash. Ct. App. 2026). “” Subsequently, Herzog’s insurer included preferred alternative prescription drug options for Herzog to discuss with a provider, such as topiramate, bupropion, and naltrexone, as well as over the counter medication, Alli. Herzog appealed his insurer’s decision declining…”
— Wash. Rev. Code § 48.43.0128(1)(a) — 3 cases
Jeannette Simonton, V. Washington State Health Care Auth. (Wash. Ct. App. 2026). “But this carveout is subject to exceptions, including under RCW 48.43.0128. Id. So, the “fair discrimination” authorization is eliminated—and the general prohibition against discrimination is not subject to the exception—if the discrimination is prohibited by RCW 48.”
Luci Solorio, V. Regence Blueshield (Wash. Ct. App. 2026). “60 RCW, and RCW 48.43.0128. The trial court denied Regence’s CR 12(b)(6) motion to dismiss and we accepted interlocutory review.”
Kurt Herzog V. Kaiser Found. Health Plan Of Washington, Et Ano (Wash. Ct. App. 2026). “” Subsequently, Herzog’s insurer included preferred alternative prescription drug options for Herzog to discuss with a provider, such as topiramate, bupropion, and naltrexone, as well as over the counter medication, Alli. Herzog appealed his insurer’s decision declining…”
— Wash. Rev. Code § 48.43.0128(2) — 3 cases
Jeannette Simonton, V. Washington State Health Care Auth. (Wash. Ct. App. 2026). “But this carveout is subject to exceptions, including under RCW 48.43.0128. Id. So, the “fair discrimination” authorization is eliminated—and the general prohibition against discrimination is not subject to the exception—if the discrimination is prohibited by RCW 48.”
Kurt Herzog V. Kaiser Found. Health Plan Of Washington, Et Ano (Wash. Ct. App. 2026). “” Subsequently, Herzog’s insurer included preferred alternative prescription drug options for Herzog to discuss with a provider, such as topiramate, bupropion, and naltrexone, as well as over the counter medication, Alli. Herzog appealed his insurer’s decision declining…”
Luci Solorio, V. Regence Blueshield (Wash. Ct. App. 2026). “60 RCW, and RCW 48.43.0128. The trial court denied Regence’s CR 12(b)(6) motion to dismiss and we accepted interlocutory review.”
— Wash. Rev. Code § 48.43.0128(7) — 1 case
Jeannette Simonton, V. Washington State Health Care Auth. (Wash. Ct. App. 2026). “But this carveout is subject to exceptions, including under RCW 48.43.0128. Id. So, the “fair discrimination” authorization is eliminated—and the general prohibition against discrimination is not subject to the exception—if the discrimination is prohibited by RCW 48.”
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